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Test Report: To Be Filled Up by Licensed Electrical Contractor

This document is a test report form for an electrical installation completed by a licensed electrical contractor at a customer's premises. It includes sections for the contractor to provide details of the job, test results for insulation and earth resistance, and certifications that electrical code and safety requirements were followed. Upon completion, the supervisor wireman and customer sign to verify the work was done correctly according to regulations.

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Bhegz Escalona
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
977 views

Test Report: To Be Filled Up by Licensed Electrical Contractor

This document is a test report form for an electrical installation completed by a licensed electrical contractor at a customer's premises. It includes sections for the contractor to provide details of the job, test results for insulation and earth resistance, and certifications that electrical code and safety requirements were followed. Upon completion, the supervisor wireman and customer sign to verify the work was done correctly according to regulations.

Uploaded by

Bhegz Escalona
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Annex 4

Test Report
To be filled up by licensed Electrical Contractor

Book No. _______________ Form No. __________________

To be filled up by the licensee

This is being issued for providing electrical connection at the premises of Mr./ Mrs./ Ms.
_________________________________ ______________. The address of the premises is
__________________________ ______________________________________________.
The name and address of the licensed electrical contractor is __________________________
__________________________________________________________________________.
The date of issue of this report is __________________________.

To be filled up by the licensed electrical contractor

5 I hereby declare that –

(a) I have ________________________ class license valid till ______________ .


The license number is _________________________________________.
(b) I have completed this work for Mr./ Mrs./ Ms. _________________________
_____________________for his ____________________________________
______________________________________________________________.
Details of Job

Sl Item 220/ 230 Volts 440/ 400 Volts


No
Red Phase Green Phase Blue Phase No Total
Watts
No Total No Total No Total
Watts Watts Watts

2
3

(c)
(i) The particulars of the employees who executed the job are tabulated
below.
Sl No. Name of the Wireman/ Trainee Designation Period

From To

(ii) The work was carried out under the supervision of


_______________________________ (Supervisor Wireman) whose
certificate number is __________________________________. He
is responsible for work carried out during the period
____________________________________.
(d) This installation specifications adhere to all the provisions of Indian Electricity
Rules 1956.
6 I also declare/ certify the following:

(a) The installed switches are of correct ratings: Yes/ No


(b) All the switches and wiring are permanent and of correct specifications
Yes/ No

(c) All plugs are of three pin type and controlled by separate switches
Yes/ No

(d) All the Single Pole switches connected to the phase Yes/ No
(e) Required permanent mark is provided on the main switch board for Neutral
point
Yes/ No

(f) Arrangement for earthing is according to Rule 61 of Indian Electricity Rules,


1956 Yes/ No
(g) In case of three phase installation
(i) Danger board, fire extinguisher with buckets, shock chart and first aid
kit have been provided for Yes/ No
(ii) The installation specifications of the switch board is as per Rule 15 of
Indian Electricity Rules, 1956 Yes/ No
7 Test results

Date of testing_______________________

Insulation to Earth Insulation between conductors

Phase 1

Phase 2

Phase 3

Earth Resistance Date of testing

Electrode No 1 Electrode No 2
8 The date of registration according to form ‘L’ of Madhya Pradesh Licensing Board
(Electricity) is as follows:

Sl No. ____________________________

Date _____________________________

Signature of the Licensed Electrical Contractor


Certificate from Supervisor wireman

It is hereby certified that the aforesaid work has been undertaken by ____________________
________________________________ who has a wireman permit number of ____________
__________________________ that is valid till ___________________________.

It is also certified that testing of the installation has been undertaken by _________________
_________________________________ who has a permit number of __________________
__________________________ that is valid till ___________________________.

Signature of the wireman Signature of Supervisor, wireman

Receipt

The test report form number ____________________for the installation at the premises of
________________________________ prepared by ______________________________
has been received on _________________________________.

Signature of Officer in Charge

Name

Designation

Date

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